Lipitor wins first round in battle of statin drugs

ORLANDO - The first head-to-head comparison of popular statin drugs suggests lowering cholesterol more aggressively than national guidelines recommend can stop dangerous clogging of the arteries.

The results address one of the biggest questions in cardiology: How low should bad cholesterol go? For now, the answer seems to be: as low as possible.

Nevertheless, other experts caution it is too soon to rewrite federal guidelines.

The study compared two popular statin pills, Lipitor and Pravachol. It found Lipitor did a considerably better job of lowering cholesterol and controlling the insidious buildup of gunk inside the arteries when given to people with serious heart disease.

Exactly why, though, is unclear. The benefit could not be totally explained by the lower cholesterol levels. Researchers wondered if some other property of Lipitor, such as its stronger effect on inflammation, accounted for its more potent effects.

The study was sponsored by Lipitor's maker, Pfizer, but the study's leader said the research was independent. A similar but larger study is nearing completion, sponsored Bristol-Myers Squibb, which makes Pravachol.

Doctors have long debated how low people with heart trouble should drive down their cholesterol. Guidelines recommend getting LDL, the bad cholesterol, down to 100. But many have wondered whether lower is better.

The latest study lowered that target to 80 and found the more rigorous treatment seemed to stop artery clogging in its tracks.

"There is no such thing as too low an LDL. That's what the data seem to show," said Dr. Steven Nissen of the Cleveland Clinic. He presented the results Wednesday at a meeting of the American Heart Association.

The study involved 654 adults with LDL over 125 who had symptoms of coronary disease. They were randomly assigned to get 40 milligrams of Pravachol or 80 milligrams of Lipitor, the top doses available of the two drugs. When the study began in 1999, Lipitor was considered to be the most powerful statin.

After 18 months, average LDL was 110 in the Pravachol patients and 79 in those on Lipitor. The volume of plaque in their arteries increased almost 3 percent in the Pravachol patients, while it regressed a fraction of 1 percent in those on Lipitor.

Julie Keenan of Bristol-Myers Squibb said the study did not measure heart complications, such as heart attacks and death, and earlier studies have shown Pravachol reduces the risk of these disasters.